Individual
MOHAMMED AL-KADIRI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 MAPLE AVENUE WEST, SUITE A, VIENNA, VA 22180
(571) 407-7004
Mailing address
305 MAPLE AVENUE WEST, SUITE A, VIENNA, VA 22180
(571) 407-7004
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036-098581
IL
261QP2300X
Primary Care Clinic/Center
0101241399
VA
261QU0200X
Urgent Care Clinic/Center
Primary
0101241399
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036098581
—
IL
01
—
06032182
BLUE CROSS BLUE SHIELD
IL
01
—
08232204
BLUE CROSS BLUE SHIELD
IL
01
—
08232205
BLUE CROSS BLUE SHIELD
IL
01
—
P00350409
RAILROAD MEDICARE
IL
Enumeration date
06/12/2006
Last updated
11/27/2023
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